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Now showing 1 - 9 of 9
  • Publication
    Psoriasis and the liver: problems, causes and course
    (WILEY, 2017) SEÇKİN GENÇOSMANOĞLU, DİLEK; Tula, Elona; Ergun, Tulin; Seckin, Dilek; Ozgen, Zuleyha; Avsar, Erol
    Background/ObjectivesPsoriasis patients have a higher risk of liver abnormalities such as non-alcoholic fatty liver disease (NAFLD), drug-induced hepatitis, alcoholic hepatitis and neutrophilic cholangitis, than the general population. Associated liver disease limits therapeutic options and necessitates careful monitoring. The aim of the study was to identify liver problems in psoriasis patients and to investigate the underlying causes as well as their course. MethodsThe files of 518 psoriasis patients were retrospectively reviewed. Among these, 393 patients with relevant laboratory data were analysed for liver enzymes and their relation to the known risk factors for liver disease (obesity, diabetes mellitus, alcohol consumption, hepatotoxic medications, dyslipidemia, psoriatic arthritis and infectious hepatitis). ResultsAmong 393 patients, 24% and 0.8% developed liver enzyme abnormalities and cirrhosis, respectively. The most common factors associated with pathological liver enzymes were drugs (57%) and NAFLD (22%). Other rare causes were alcoholic hepatitis, viral hepatitis, neutrophilic cholangitis, autoimmune hepatitis and toxic hepatitis due to herbal therapy. Drug-induced liver enzyme abnormalities were reversible whereas in patients with NAFLD transaminases tended to fluctuate. One patient with herbal medicine-related cirrhosis died of sepsis. ConclusionLiver enzyme abnormalities are common in psoriasis patients and are mostly associated with drugs and NAFLD. Although most cases can be managed by avoiding hepatotoxic medications and close follow up, severe consequences like cirrhosis may develop.
  • Publication
    Demographic, clinical and treatment characteristics of patients with Kaposi's sarcoma: A single-center study
    (MARMARA UNIV, FAC MEDICINE, 2019-05-29) SALMAN, ANDAÇ; Salman, Andac; Ozgen, Zuleyha
    Objective: The clinical, demographic and treatment characheristics of patients with Kaposi's sarcoma (KS) are not well-detined. There is lack of consensus on treatment modalities. Thus, we aimed to define demographic, clinical characteristics and treatment outcomes in our cohort of patients with KS. Patients and Methods: A retrospective cohort study was done and all patients who were followed up in our specialized cutaneous tumors outpatient clinic with a diagnosis of KS between 2006 and 2018 were included in the study. Results: A total of 25 patients were included in the study. The mean age of the patients was 66 and 80% were male. The most common form of KS was classic type (80%). During a mean follow-up of 43 months, the most frequently administered treatments were cryotherapy, interferons, radiotherapy, topical imiquimod and topical timolol. Overall a complete response was observed in 9 (36%) patients. Conclusion: The clinical and demographic characteristics of our cohort match those observed in existing literature. We think that the use of local treatments such as cryotherapy, topical imiquimod should be used more frequently in patients with limited disease. Considering the efficacy of timolol in other vascular tumors, future prospective studies investigating the effects of timolol in KS are highly warranted.
  • Publication
    Effect of Dental Follicle Mesenchymal Stem Cells on Th1 and Th2 Derived Naive T Cells in Atopic Dermatitis Patients
    (MARMARA UNIV, INST HEALTH SCIENCES, 2019-08-31) GÖKER, MEHMET KAMİL; Zibandeh, Noushin; Genc, Deniz; Ozgen, Zuleyha; Duran, Yazgul; Kasap, Nurhan; Goker, Kamil; Baris, Safa; Ergun, Tulin; Akkoc, Tunc
    Objective: The purpose of our study is to investigate the immunomodulatory effects of Dental Follicle Mesenchymal Stem Cells (DF-MSCs) on lymphocytes isolated from peripheral blood of Atopic Dermatitis (AD) patients, a Th2 disease and psoriasis, a Th1 / Th17 disease and compare them with healthy individuals in vitro. Methods: Patients with the AD (n = 9) and psoriasis (n = 6) who are followed up in Marmara University Pediatric Allergy and Immunology and Dermatology outpatient clinics and healthy subjects (n = 6) were included. Peripheral Blood Mononuclear Cells (PBMCs) were isolated from 20 ml of venous blood of all participants. Cells were cultured for 72 hours in the absence and presence of DF-MSCs with anti-CD3/anti-CD28 stimulation or without stimulation. At the end of this period, CD4+ and CD8+ T lymphocyte proliferation and cytokine levels from the culture supernatants were analyzed by flow cytometry. Results: In the presence of DF-MSCs, proliferation ratio was suppressed in both CD4+ and CD8+ cells in AD and psoriasis patients (p<0,05). IFN-gamma levels significantly increased in AD patients in the presence of DF-MSCs (p<0,05) whereas decreased significantly in psoriasis patients in the presence of DF-MSCs (p<0,05). IL-4 levels significantly decreased in AD patients in the presence of DF-MSCs (p<0,05) but remained unchanged in psoriasis patients (p>0,05). IL-10 increased significantly in both groups in the presence of DF-MSCs (p<0,05). Conclusion: Our results support immunoregulatory effects of DF-MSCs on both AD and psoriasis which are Th2 and Th1 / Th17 dominant diseases respectively. Our evidence-based results demonstrated that DF-MSCs could have a beneficial therapeutic implication for inflammatory skin diseases.
  • Publication
    Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions
    (SPRINGER, 2015) SEÇKİN GENÇOSMANOĞLU, DİLEK; Sunbul, Murat; Seckin, Dilek; Durmus, Erdal; Ozgen, Zuleyha; Bozbay, Mehmet; Bozbay, Ayfer; Kivrak, Tarik; Oguz, Mustafa; Sari, Ibrahim; Ergun, Tulin; Agirbasli, Mehmet
    Arterial stiffness is associated with increased cardiovascular risk. Pulse wave velocity (PWV) and augmentation index (AIx) are non-invasive markers for assessment of arterial stiffness. Increased arterial stiffness is associated with atherosclerosis in patients with psoriasis. Previous studies have shown that high neutrophil-to-lymphocyte ratio (NLR) predicts poor cardiovascular outcome. The aim of this study was to evaluate arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Fifty consecutive patients with the diagnosis of psoriasis and 50 controls were included in the study. NLR was calculated as the ratio of neutrophil count to lymphocyte count. All patients underwent echocardiographic examination. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriograph system. Fifty patients with psoriasis (26 male, mean age 43.3 +/- 13.2 years) and 50 controls (33 male, mean age 45.0 +/- 6.1 years) were included into the study. The distribution of cardiovascular risk factors was similar between the two groups, and NLR was significantly higher in patients with psoriasis (2.74 +/- 1.78 versus 1.82 +/- 0.52, p = 0.002). There was a weak correlation between NLR and PASI score without reaching statistical significance (r = 0.300, p = 0.060). While echocardiographic and hemodynamic parameters were comparable between psoriasis and control groups, heart rate was significantly higher in psoriasis group (81.5 +/- 15.1 and 75.2 +/- 11.8 beats/min, p = 0.021). Psoriasis patients had significantly higher AIx and PWV values as compared to controls (25.8 +/- 13.1 versus 17.4 +/- 12.3 %, p = 0.001 and 6.78 +/- 1.42 versus 6.18 +/- 0.80 m/s, p = 0.011, respectively). AI and PWV were significantly associated with psoriasis when adjusted by heart rate (p = 0.005, odds ratio 1.04, 95 % confidence interval 1.01-1.08 and p = 0.035, odds ratio 1.52, 95 % confidence interval 1.02-2.26, respectively). PWV significantly correlated with blood pressure, lipid levels, and several echocardiographic indices. AIx only correlated with left atrial diameter (r = 291, p = 0.040). Linear regression analysis was performed to find predictors of PWV. Central systolic blood pressure, left atrial diameter, and total cholesterol were independent predictors of PWV. PWV and AIx were significantly higher in patients with psoriasis. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in psoriasis patients with normal cardiac functions. Novel inflammatory biomarkers such as NLR may elucidate the mechanism of vascular dysfunction in such patients.
  • Publication
    Rituximab therapy in pediatric pemphigus patients: A retrospective analysis of five Turkish patients and review of the literature
    (WILEY, 2019) ÖZGEN, ZÜLEYHA; Bilgic-Temel, Asli; Ozgen, Zueleyha; Harman, Mehmet; Kapicioglu, Yelda; Uzun, Soner
    Background/Objectives There is inadequate knowledge regarding rituximab (RTX) administration in autoimmune bullous diseases (AIBDs), disease prevalence, clinical characteristics, and treatment outcomes within pediatric populations due to the rarity of AIBDs affecting the pediatric age group. The aim of this retrospective analysis was to evaluate the effectiveness, safety of RTX, and treatment outcomes in Turkish pediatric patients with pemphigus vulgaris (PV) and to review the literature. Methods Five patients under 18 years of age and diagnosed with PV received RTX treatment and were identified in four dermatology departments of Turkey. Results The mean age of the patients at the time of RTX therapy initiation was 15 years (range: 11-17 years), and the total duration of follow-up after RTX therapy was 42.6 months (range: 19-60 months). All patients showed a clinical response. At the last visit, complete remission off therapy was achieved in three patients. The remaining two patients achieved partial remission off therapy. No adverse events were observed. Conclusions This retrospective case series of five pediatric patients showed that RTX treatment can be effective and safe for the treatment of recalcitrant PV in pediatric patients. With increasing evidence, RTX is a good treatment choice in adults and pediatric patients with pemphigus.
  • Publication
    The risk of tuberculosis in patients with psoriasis treated with anti-tumor necrosis factor agents
    (WILEY-BLACKWELL, 2015) SEÇKİN GENÇOSMANOĞLU, DİLEK; Ergun, Tulin; Seckin, Dilek; Bulbul, Emel Baskan; Onsun, Nahide; Ozgen, Zuleyha; Unalan, Pemra; Alpsoy, Erkan; Karakurt, Sait
    BackgroundTumor necrosis factor-alpha (TNF-) antagonist treatment is associated with 1.6 to 27 times higher risk of tuberculosis (TB). ObjectiveTo find TB incidence of psoriasis patients treated with TNF- antagonists and define risk factors related with this condition in a country with moderately high risk of TB. MethodsThree hundred seventy psoriasis patients treated by anti-TNF agents in four referral centers were included. The data on the characteristics of the patients, TB history, tuberculosis skin test results, anti-TNF agent type and exposure time, localization of TB, and isoniazide prophylaxis state were analyzed. ResultsFour patients (1.08%) developed TB, three pulmonary and one gastrointestinal, 2-23months after initiating anti-TNF agents. Other than the patient with gastrointestinal TB, who was using methotrexate and corticosteroid concomitantly, none had contributing risk factors for TB. Two patients developed pulmonary TB in spite of chemoprophylaxis. Three patients with pulmonary TB completely recovered following antiTB treatment whereas patients with gastroinrestinal TB developed renal failure. LimitationsThe major limitation of the study is the lack of a diseased control group, which enables us to compare the risk of psoriatics with that of patients having other inflammatory diseases. ConclusionTuberculosis is a rare but a severe complication of anti-TNF treatment and may develop in spite of chemoprophylaxis. The risk of TB in psoriasis patients in the present study is comparable to literature mostly based on rheumatology patients.
  • Publication
    Growth Arrest-Specific 6 and Cardiometabolic Risk Factors in Patients with Psoriasis
    (WILEY, 2015-04) SEÇKİN GENÇOSMANOĞLU, DİLEK; Sunbul, Murat; Cagman, Zeynep; Gerin, Fethullah; Ozgen, Zuleyha; Durmus, Erdal; Seckin, Dilek; Ahmad, Sarfraz; Uras, Fikriye; Agirbasli, Mehmet
    ObjectivesAn increased risk for cardiovascular disease with psoriasis has been reported. Growth Arrest-Specific 6 (GAS6) amplifies pro-inflammatory endothelial cell activation via TAM receptors. However, it also inhibits inflammation by multiple mechanisms including phagocytosis. The objective of this study was to investigate whether plasma GAS6 levels are associated with conventional cardiometabolic (CM) risk factors in patients with psoriasis. MethodsForty patients diagnosed with psoriasis (22 male, mean age: 43.313.8years) and 40 age-/sex-matched healthy controls (22 male, mean age: 39.38.9years) were included in the study. CM risk factors (hypertension, hyperlipidemia, diabetes mellitus, and cigarette smoking) were identified. GAS6 levels were measured by ELISA. ResultsThere were no significant differences between the plasma GAS6 levels of patients with psoriasis compared to the control group (6.6 +/- 2.0ng/mL, 7.6 +/- 2.8ng/mL, respectively, P>0.05). However, GAS6 levels of patients with psoriasis having a smoking history (n=11) were significantly lower than both patients with psoriasis who had no smoking history (n=29) and controls (5.5 +/- 1.7ng/mL, 6.9 +/- 1.9ng/mL, 7.6 +/- 2.8ng/mL, respectively, P<0.05). Similarly, psoriasis patients with at least one CM risk factor showed lower GAS6 levels compared to subjects without any CM risk factor (5.7 +/- 1.7ng/mL, 7.3 +/- 2.0ng/mL, P<0.01). There was no correlation between the GAS6 level, disease duration or PASI score (r=0.150, -0.150, and P=0.310, 0.398, respectively). ConclusionsThis pilot study provides the first evidence in humans for an association between low plasma GAS6 levels and conventional risk factors in psoriasis. Further large scale, prospective studies are needed to confirm these results.
  • Publication
    Mesenchymal stem cells derived from human dental follicle modulate the aberrant immune response in atopic dermatitis
    (FUTURE MEDICINE LTD, 2021) BARIŞ, SAFA; Zibandeh, Noushin; Genc, Deniz; Ozgen, Zuleyha; Duran, Yazgul; Goker, Kamil; Baris, Safa; Ergun, Tulin; Akkoc, Tunc
    Background: Atopic dermatitis (AD) is an inflammatory cutaneous disorder. The advancements in the understanding of AD immunological pathogenesis have caused the development of therapies that suppress the dysregulated immune response. We aimed to evaluate the immunomodulatory effect of dental stem cells (dental follicle-mesenchymal stem cells [DF-MSCs]) on AD patients. Materials & methods: We investigated the immunoregulatory potential of DF-MSCs on T cell response in AD and compared them with psoriasis and healthy individuals and the underlying mechanisms. Results: DF-MSCs significantly reduced Fas, FasL and TNFR II frequency in T cells, increased naive T cell population while reducing memory T cell, decreased inflammatory cytokine levels and promoted Tregs frequency in the AD population. Conclusion: These results imply that DF-MSCs are modulating inflammation through decreasing T cell apoptosis, inducing Treg expansion and stabilizing cytokine levels. Lay abstract Background: Atopic dermatitis (AD) is an inflammatory cutaneous disorder characterized by immune-mediated inflammation and epidermal barrier dysfunction. There is no definite solution for the treatment of AD. We aimed to evaluate the immunomodulatory and immunosuppressive effect of dental stem cells (dental follicle-mesenchymal stem cell [DF-MSCs]) on AD. Materials & methods: We investigated the immunoregulatory potential of DF-MSCs on inflammatory response in AD and compared them with psoriasis and healthy individuals and the mechanism underlying it. Results: DF-MSCs significantly reduced apoptosis-related markers in immune cells, decreased inflammatory cytokine levels and promoted Treg frequency in the AD. Conclusion: Our findings provide basic evidence for the potential role of DF-MSCs as a cellular therapy option in the treatment of AD and shed light on future clinical studies.
  • Publication
    Immunmodulation in the treatment of dermatological diseases
    Immunological effects have an important role in the action mechanisms of the majority of topical and systemic agents, and even some physical treatment modalities in dermatology. Depending on the disease being treated, these effects may be suppression or stimulation of the immune system as well as modulation of the existing functions. Agents that show their effects mainly by immunmodulation in the treatment of dermatological diseases are discussed in the present article. Treatment alternatives included in the article, azathioprine, mycophenolate mofetil, cyclosporine, glucocorticosteroids, topical calcineurin inhibitors, photo(chemo)therapy, intravenous immunoglobuline, interferon, rituximab, omalizumab, imiquimod and extracorporeal photopheresis are discussed focusing especially on their immunomodulatory effects without any mention on their prescribing details, treatment protocols and monitorization aspects.